Percutaneous balloon mitral valvuloplasty: the learning curve.

PBMV is a catheter-based approach to nonsurgically relieving obstruction to mitral inflow in patients with symptomatic mitral stenosis. Since 1986, 50 patients at the Mayo Clinic have undergone the procedure, utilizing either the Inoue pillow-shaped balloon or a dual-balloon technique with excellent early hemodynamic and symptomatic results. Mean mitral valve area increased from 1.06 +/- 0.32 cm2 to 2.01 +/- 0.70 cm2, and transmitral gradient decreased from 15.7 +/- 7.1 mm Hg to 7.5 +/- 3.9 mm Hg. This improvement has been sustained during short-term and intermediate-term follow-up. A marked improvement in procedural success and complication rates is attributable to refinement of patient selection criteria, technical advances in the procedure, and operator experience. There have been three procedure-related deaths; one of these was in a patient who developed severe mitral regurgitation after PBMV and underwent emergency valve replacement. Unfavorable outcomes appear to be related to three factors: presence of thick, calcified valve leaflets with extensive subvalvular involvement, poor general medical status, and operator inexperience.

[1]  I. Palacios,et al.  Prediction of successful outcome in 130 patients undergoing percutaneous balloon mitral valvotomy. , 1990, Circulation.

[2]  J. Hill,et al.  The M-Heart percutaneous balloon mitral Valvuloplasty Registry: initial results and early follow-up. The M-Heart Group. , 1990, Journal of the American College of Cardiology.

[3]  McKay Cr.  Should patients with mitral stenosis who are acceptable surgical commissurotomy candidates now have balloon valvuloplasty treatment , 1990 .

[4]  R GORLIN,et al.  Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. I. , 1951, American heart journal.

[5]  N. Nanda,et al.  Color Doppler assessment of mitral regurgitation with orthogonal planes. , 1987, Circulation.

[6]  X. Wang,et al.  Value of two-dimensional echocardiography in selecting patients and balloon sizes for percutaneous balloon mitral valvuloplasty. , 1989, Journal of the American College of Cardiology.

[7]  I. Palacios,et al.  Follow-up of patients undergoing percutaneous mitral balloon valvotomy. Analysis of factors determining restenosis. , 1989, Circulation.

[8]  J. Allen,et al.  Percutaneous double balloon valvotomy for severe rheumatic mitral stenosis. , 1990, The American journal of cardiology.

[9]  I. Palacios,et al.  Responsiveness of plasma atrial natriuretic factor to short-term changes in left atrial hemodynamics after percutaneous balloon mitral valvuloplasty. , 1988, Journal of the American College of Cardiology.

[10]  D. Holmes,et al.  Percutaneous balloon valvuloplasty. , 1990, Mayo Clinic proceedings.

[11]  G. Dorros,et al.  Percutaneous mitral valvuloplasty: retrograde, transarterial double-balloon technique utilizing the transseptal approach. , 1988, Catheterization and cardiovascular diagnosis.

[12]  L Hatle,et al.  Noninvasive Assessment of Atrioventricular Pressure Half‐time by Doppler Ultrasound , 1979, Circulation.

[13]  J. F. Keane,et al.  Percutaneous catheter commissurotomy in rheumatic mitral stenosis. , 1985, The New England journal of medicine.

[14]  T. Cheng,et al.  Percutaneous mitral valvuloplasty with a single rubber-nylon balloon (Inoue balloon): long-term results in 71 patients. , 1990, American heart journal.

[15]  A. Vahanian,et al.  Results of percutaneous mitral commissurotomy in 200 patients. , 1989, The American journal of cardiology.

[16]  B. Nowak,et al.  Experimental balloon valvuloplasty of fibrotic and calcific mitral valves. , 1990, Circulation.

[17]  I. Palacios,et al.  Mitral regurgitation after percutaneous balloon mitral valvuloplasty in adults: evaluation by pulsed Doppler echocardiography. , 1988, Journal of the American College of Cardiology.

[18]  I. Palacios,et al.  Percutaneous balloon mitral valvotomy for patients with mitral stenosis. Analysis of factors influencing early results. , 1988, The Journal of thoracic and cardiovascular surgery.

[19]  K Inoue,et al.  Clinical application of transvenous mitral commissurotomy by a new balloon catheter. , 1984, The Journal of thoracic and cardiovascular surgery.

[20]  P. Ribeiro,et al.  Comparison of results of percutaneous balloon mitral valvotomy using single and double balloon techniques. , 1989, American Journal of Cardiology.

[21]  C. McKay,et al.  Mechanisms of increase in mitral valve area and influence of anatomic features in double-balloon, catheter balloon valvuloplasty in adults with rheumatic mitral stenosis: a Doppler and two-dimensional echocardiographic study. , 1987, Circulation.

[22]  T. Cheng,et al.  Percutaneous transseptal balloon mitral valvuloplasty: the Chinese experience in 30 patients. , 1988, American heart journal.

[23]  P. Ribeiro,et al.  One-year follow-up after percutaneous double balloon mitral valvotomy. , 1989, The American journal of cardiology.

[24]  I. Palacios,et al.  Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. , 1988, British heart journal.

[25]  A. Berman,et al.  Balloon dilation of mitral stenosis in adult patients: postmortem and percutaneous mitral valvuloplasty studies. , 1987, Journal of the American College of Cardiology.

[26]  I. Palacios,et al.  Percutaneous balloon valvotomy for patients with severe mitral stenosis. , 1987, Circulation.

[27]  R. Karas,et al.  In vitro analysis of mechanisms of balloon valvuloplasty of stenotic mitral valves. , 1987, The American journal of cardiology.